July 2010 Briefing - Surgery

Here are what the editors at HealthDay consider to be the most important developments in Surgery for July 2010. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

'Ablate and Wait' Effective for Hepatocellular Carcinoma

FRIDAY, July 30 (HealthDay News) -- The use of tumor ablation followed by a period of observation for all patients with hepatocellular carcinoma (HCC) listed for transplant may be an effective strategy, as it may eliminate patients whose disease is likely to recur after transplantation, according to an opinion piece published online July 23 in Liver Transplantation.

FRIDAY, July 30 (HealthDay News) -- Preemptive analgesia using continuous subcutaneous morphine combined with a single intrathecal injection of morphine (SI) in patients who undergo posterior lumbar interbody fusion provides a favorable analgesic effect and compares favorably with continuous subcutaneous morphine alone (SC), according to a study published in the July issue of the Journal of Spinal Disorders & Techniques.

FRIDAY, July 30 (HealthDay News) -- Most medical specialties saw modest compensation increases in 2009, but many provider organizations are still operating at a substantial loss, according to the findings of the American Medical Group Association's (AMGA) 2010 Medical Group Compensation and Financial Survey.

THURSDAY, July 29 (HealthDay News) -- Preterminal clinical conditions in young organ donors may result in increased inflammatory infiltration of the pancreas and increased β-cell replication after prolonged life support, according to a study published in the July issue of Diabetes.

THURSDAY, July 29 (HealthDay News) -- Patients who undergo a primary total hip or knee replacement procedure with general anesthesia have a higher risk of surgical site infection (SSI) than those who undergo the procedure with epidural/spinal anesthesia, according to a study published in the August issue of Anesthesiology.

THURSDAY, July 29 (HealthDay News) -- After correcting for the natural weight gain expected with aging, many patients experience a decrease in weight and body mass index (BMI) after total knee or total hip replacement, according to research published in the June 1 issue of Orthopedics.

WEDNESDAY, July 28 (HealthDay News) -- The range of motion (ROM) resulting from cervical disc arthroplasty is associated with preoperative factors and factors related to the surgical procedure itself, according to a pair of studies published in the August issue of The Spine Journal.

TUESDAY, July 27 (HealthDay News) -- Serious complications associated with bariatric surgery are relatively low in Michigan patients, especially if their operations are performed by high-volume surgeons or in high-volume hospitals, regardless of whether the hospital is an accredited Center of Excellence (COE), according to research published in the July 28 issue of the Journal of the American Medical Association.

TUESDAY, July 27 (HealthDay News) -- Hospitals, and to a lesser extent surgeons, who have a low volume of coronary artery bypass graft (CABG) surgeries tend to incur higher costs, according to research published in the July 26 issue of the Archives of Internal Medicine.

MONDAY, July 26 (HealthDay News) -- There are significant regional variations in the odds of Medicare beneficiaries undergoing a carotid revascularization procedure, according to research published in the July 26 issue of the Archives of Internal Medicine.

MONDAY, July 26 (HealthDay News) -- Most men diagnosed with prostate cancer who have a prostate-specific antigen (PSA) threshold below 4.0 ng/mL undergo aggressive local therapy despite having low-risk disease, according to research published in the July 26 issue of the Archives of Internal Medicine.

MONDAY, July 26 (HealthDay News) -- Increasing surgical volume may reduce the operating time for laparoscopic hysterectomy and also lower the risk for conversion to laparotomy, but high- and low-volume surgeons have similar rates of serious complications, according to a study in the July issue of the American Journal of Obstetrics & Gynecology.

FRIDAY, July 23 (HealthDay News) -- Pre-hospital triage of ST-segment elevation myocardial infarction (STEMI) with direct transport to an intervention center is associated with decreased symptom-to-balloon time and a lower mortality rate, according to research published in the July issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

FRIDAY, July 23 (HealthDay News) -- The 15-point Spine Severity Score (SSS) rating system is a reliable tool for experts and non-experts alike to use for the triage of elective spine referrals, according to a study in the August issue of The Spine Journal.

THURSDAY, July 22 (HealthDay News) -- Vaginal birth after cesarean (VBAC) is a safe option for most women who have had one prior cesarean delivery and for some who have had two prior cesarean deliveries, according to new guidelines released by the American College of Obstetricians and Gynecologists and published in the August issue of Obstetrics & Gynecology.

WEDNESDAY, July 21 (HealthDay News) -- Among young, physically active adults with acute anterior cruciate ligament (ACL) tears, rehabilitation with optional delayed ligament reconstruction is associated with similar outcomes as rehabilitation plus early reconstruction, and it reduces the rate of reconstruction, according to research published in the July 22 issue of the New England Journal of Medicine.

WEDNESDAY, July 21 (HealthDay News) -- Melanoma specialists who are not dermatologists tend to excise thin invasive melanomas to a deeper level than do dermatologist specialists and non-specialists, according to research published online July 19 in the Archives of Dermatology.

TUESDAY, July 20 (HealthDay News) -- About 5 percent of the application essays to residency programs -- often referred to as the personal statement -- contain plagiarized material, according to research published in the July 20 issue of the Annals of Internal Medicine.

TUESDAY, July 20 (HealthDay News) -- The incidence of post-surgical sepsis is higher than the incidence of post-surgical myocardial infarction or pulmonary embolism, and risk factors for sepsis include older age, need for emergency surgery, and comorbidities, according to research published in the July issue of the Archives of Surgery.

TUESDAY, July 20 (HealthDay News) -- During emergency surgery, transfusing a trauma patient with his or her own blood offers an effective and less costly alternative to transfusion with allogeneic blood, according to a report in the July issue of the Archives of Surgery.

MONDAY, July 19 (HealthDay News) -- A surgery resident's decision to pursue fellowship training is largely due to a desire for clinical mastery and specialty activities regardless of gender, with lifestyle factors of only midrange importance and program size appearing more influential than gender, according to research published in the July issue of the Archives of Surgery.

FRIDAY, July 16 (HealthDay News) -- Minimally invasive total knee arthroplasty does not confer a significant advantage over a conventional approach, according to research published in the July 7 issue of the Journal of Bone & Joint Surgery.

FRIDAY, July 16 (HealthDay News) -- The presence of "ghosts" -- or intracardiac masses noted on echocardiography after device removal -- suggests device infection and may be associated with cardiac device-related infective endocarditis (CDRIE); these ghosts are present in 8 percent of patients after percutaneous device removal, according to research published in the July issue of the Journal of the American College of Cardiology: Cardiovascular Imaging.

THURSDAY, July 15 (HealthDay News) -- Anterior cervical discectomy and fusion (ACDF) became more prevalent over a recent 15-year period, with the largest increase in utilization seen in patients aged 65 and older, according to research published in the July 1 issue of Spine.

TUESDAY, July 13 (HealthDay News) -- While physicians generally acknowledge their responsibility to report an impaired or incompetent colleague to authorities, many do not actually report incompetent colleagues when faced with this situation, according to the results of a survey published in the July 14 issue of the Journal of the American Medical Association.

MONDAY, July 12 (HealthDay News) -- There is little difference in cosmetic outcomes for patients whose cesarean section wounds were closed by staples and those whose wounds were closed with subcuticular sutures, according to research published in the July issue of the American Journal of Obstetrics & Gynecology.

MONDAY, July 12 (HealthDay News) -- Elderly patients can benefit from lumbar spinal fusion in terms of reduced leg and back pain, and age alone is not a contraindication, according to a study in the July 1 issue of Spine.

FRIDAY, July 9 (HealthDay News) -- Influenza A H1N1 can cause substantial morbidity and mortality in solid organ transplant recipients; however, initiation of antiviral therapy within 48 hours of symptom development may decrease intensive care unit (ICU) admissions, according to a study published online July 9 in the The Lancet: Infectious Diseases.

FRIDAY, July 9 (HealthDay News) -- An anesthesiologist who reused a contaminated single-use propofol vial on multiple endoscopy patients caused an outbreak of hepatitis infection affecting 13 patients at two clinics, according to a report published in the July issue of Gastroenterology.

THURSDAY, July 8 (HealthDay News) -- Improvements in insulin resistance that occur in the first week after Roux-en-Y gastric bypass (RYGB) surgery appear to be due mostly to caloric restriction, according to research published in the July issue of Diabetes Care.

WEDNESDAY, July 7 (HealthDay News) -- Ten years after graduation, approximately one-fourth of doctors work in a specialty other than the one they chose in their third year post-graduation, according to research published online July 6 in BMJ.

TUESDAY, July 6 (HealthDay News) -- Survival following lung transplantation varies between transplantation centers, and the variation is only partially associated with volume of procedures, according to research published in the July 7 issue of the Journal of the American Medical Association.

MONDAY, July 5 (HealthDay News) -- A mandatory second opinion to interpret prostate needle biopsy prior to radical prostatectomy in a few cases results in differences that may affect therapy, according to research published in the July issue of the The Journal of Urology.

FRIDAY, July 2 (HealthDay News) -- About one out of five Medicare patients with lumbar spinal stenosis (LSS) receives surgery within three years of diagnosis, and there appears to be an association between the type of surgery provided and the point after diagnosis when surgery is carried out, according to research published in the July issue of The Spine Journal.

THURSDAY, July 1 (HealthDay News) -- In a new report, the Association of American Medical Colleges (AAMC) urges U.S. teaching hospitals to establish policies that ensure financial relationships between physicians and industry do not result in conflicts of interest that influence patient care.

THURSDAY, July 1 (HealthDay News) -- More than 2 billion people worldwide do not have adequate access to surgical services, and low-income countries in particular have low levels of surgical care, according to a study published online July 1 in The Lancet.

THURSDAY, July 1 (HealthDay News) -- Patients who receive a commonly used axial flow pump, the HeartMate II (HM II), are at high risk for major bleeding during both long-term support and heart transplantation, possibly due to acquired von Willebrand syndrome, according to research published online June 30 in the Journal of the American College of Cardiology.

THURSDAY, July 1 (HealthDay News) -- Extraction of Sprint Fidelis defibrillator leads can be performed safely in high-volume settings, though longer implantation duration is associated with greater need for countertraction sheath (CTS) assistance, according to research published online June 30 in the Journal of the American College of Cardiology.

THURSDAY, July 1 (HealthDay News) -- Obese individuals who undergo lumbar microdiscectomy are much more likely than non-obese individuals to experience recurrent herniation of the nucleus pulposus (HNP), according to research published in the July issue of The Spine Journal.